慢性阻塞性肺疾病合并肺动脉高压患者血清多药耐药蛋白4水平的变化及临床意义  

Change and clinical significance of serum multidrug resistance protein 4 level in patients with chronic obstructive pulmonary disease complicated with pulmonary hypertension

作　　者：黄芳 余倩[2] 韩婧[2] 刘维佳[3] Huang Fang;Yu Qian;Han Jing;Liu Weijia(Clinical Medical College,Guizhou Medical University,Guiyang 550004,China;Department of Respiratory and Critical Care Medicine,Guizhou Provincial People′s Hospital,Guiyang 550002,China;Guizhou Medical University,Department of Respiratory and Critical Care Medicine,Guizhou Provincial People′s Hospital,Clinical Research Center for Respiratory Diseases of Guizhou Province,Key Laboratory of Diagnosis and Treatment of Pulmonary Immune Diseases of National Health Commission,Central Laboratory of Guizhou Provincial People′s Hospital,Guiyang 550002,China)

机构地区：[1]贵州医科大学临床医学院,贵阳550004 [2]贵州省人民医院呼吸与危重症医学科,贵阳550002 [3]贵州医科大学贵州省人民医院呼吸与危重症医学科、贵州省呼吸疾病临床研究中心、国家卫生健康委员会肺脏免疫性疾病诊治重点实验室、贵州省人民医院中心实验室,贵阳550002

出　　处：《中国医药》2024年第9期1319-1324,共6页China Medicine

基　　金：贵州省科技计划项目(黔科合基础-ZK[2022]一般248、黔科合基础-ZK[2024]一般477);贵州省卫生健康委科学技术基金项目(gzwkj2021-089、gzwkj2021-091、gzwkj2024-011)。

摘　　要：目的探讨多药耐药蛋白4(MRP4)在慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者血清中的表达及临床意义。方法选取2023年2月13日至2024年2月13日贵州省人民医院住院确诊COPD患者150例,根据超声心动图结果将COPD患者分为COPD组(50例)和COPD合并PH组(COPD+PH组,100例)。另选取本院同期体检健康受试者50例作为对照组;按肺动脉收缩压(PASP),将COPD+PH组分为轻度组[36 mmHg(1 mmHg=0.133 kPa)≤PASP≤50 mmHg]、中度组(51 mmHg≤PASP≤70 mmHg)和重度组(PASP>70 mmHg)。检测MRP4、肺功能、血气分析指标、红细胞体积分布宽度(RDW)、平均血小板体积(MPV)、B型脑钠肽(BNP)及白蛋白水平。Pearson相关性模型进行相关性分析;受试者工作特征(ROC)曲线评估MRP4预测COPD合并PH的价值。结果COPD组MRP4水平低于对照组,COPD+PH组MRP4水平高于对照组和COPD组(均P<0.05)。COPD+PH组白蛋白水平低于COPD组,RDW、MPV、BNP水平均高于COPD组(均P<0.05)。中度组、重度组MRP4、RDW、MPV、BNP水平均高于轻度组,且重度组均高于中度组;白蛋白水平均低于轻度组,且重度组低于中度组(均P<0.05)。COPD+PH组患者MRP4水平与BNP、PASP、RDW、MPV呈正相关(r=0.72、0.85、0.70、0.62,均P<0.01),与白蛋白呈负相关(r=-0.60,P<0.01)。ROC曲线分析结果显示,当MRP4截断值为2.895μg/L时,预测COPD合并PH的曲线下面积为0.917(95%置信区间:0.865~0.970),敏感度为93.00%,特异度为88.00%。结论MRP4在COPD合并PH患者血清中高表达,其可能是潜在的生物标志指标。Objective To investigate the expression and clinical significance of multidrug resistance protein 4(MRP4)in serum of patients with chronic obstructive pulmonary disease(COPD)complicated with pulmonary hypertension(PH).Methods A total of 150 COPD patients hospitalized in Guizhou Provincial People′s Hospital from February 13,2023 to February 13,2024 were selected.According to the results of echocardiography,COPD patients were divided into COPD group(50 cases)and COPD combined with PH group(COPD+PH group,100 cases).In addition,50 healthy subjects in the same period were selected as the control group.According to pulmonary artery systolic pressure(PASP),the COPD+PH group was divided into mild group(36 mmHg≤PASP≤50 mmHg),moderate group(51 mmHg≤PASP≤70 mmHg)and severe group(PASP>70 mmHg).MRP4,pulmonary function,blood gas analysis,red cell volume distribution width(RDW),mean platelet volume(MPV),brain natriuretic peptide(BNP)and albumin levels were measured.Pearson correlation model was used for correlation analysis.The receiver operating characteristic(ROC)curve was used to evaluate the value of MRP4 in predicting COPD combined with PH.Results The level of MRP4 in COPD group was lower than that in control group,while the level of MRP4 in COPD+PH group was higher than that in control group and COPD group(both P<0.05).The level of albumin in COPD+PH group was lower than that in COPD group,and the levels of RDW,MPV and BNP were higher than those in COPD group(all P<0.05).The levels of MRP4,RDW,MPV and BNP in moderate group and severe group were higher than those in mild group,and those in severe group were higher than those in moderate group;the albumin level was lower in the mild group than in the severe group,and that in the severe group was lower than that in the moderate group(all P<0.05).The level of MRP4 in COPD+PH group was positively correlated with BNP,PASP,RDW and MPV(r=0.72,0.85,0.70,0.62,all P<0.01),and negatively correlated with albumin(r=-0.60,P<0.0l).ROC curve analysis showed that when the cut-off

关 键 词：慢性阻塞性肺疾病 肺动脉高压 多药耐药蛋白4 

分 类 号：R563[医药卫生—呼吸系统]